MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN CINCINNATI, DAYTON, OHIO AREAS
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Community Insurance Co. to offer a Medicare managed care plan to Medicare beneficiaries in six counties in southwestern Ohio, including the cities of Cincinnati and Dayton, as part of a demonstration program announced by Health and Human Services Secretary Tommy G. Thompson. The health plans under this program are modeled after coverage offered by preferred provider organizations (PPOs) to most Americans under age 65.
Community Insurance, based in Mason, Ohio, can begin on Oct. 1, 2003, to serve Medicare beneficiaries in the six counties of Butler, Clermont, Greene, Hamilton, Montgomery and Warren. About 330,000 beneficiaries live in these counties. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment.
"We are pleased that Community Insurance Co. has decided to offer this new PPO option to Medicare beneficiaries in the Cincinnati and Dayton areas," HHS Secretary Tommy G. Thompson said. "The demonstration program gives seniors new options for their Medicare coverage similar to that available in the private insurance market. Greater access and expanded options and choices in health care are key goals of this Administration."
Congress created Medicare+Choice in the Balanced Budget Act of 1997 to expand the types of health care options available to Medicare beneficiaries, enabling them to receive new preventive benefits and greater patient protections. Preferred provider type coverage was previously unavailable to Medicare beneficiaries.
Community Insurance, which does business as Anthem Blue Cross and Blue Shield, is a subsidiary of Anthem Inc., based in Indianapolis, Ind. The plan, which operates as Anthem Medicare Preferred, gives another health care choice to the beneficiaries living in the six counties. The other Medicare+Choice plans currently operating in one or more of the six counties are Health Services Link, United Health Insurance Co., United Health Care of Ohio and United HealthCare Insurance Co.
"Whether beneficiaries enroll in a PPO or another Medicare+Choice plan, or fee-for-service Medicare, we are doing more to guarantee they understand the Medicare options available to them," CMS Administrator Tom Scully said. "The under age 65 market is rapidly flocking toward PPO products, which give patients the flexibility they need. Seniors want the same options and this is the first big step in getting them there."
Currently, Medicare+Choice health maintenance organizations (HMOs) are available where private companies choose to offer them. About 4.6 million Medicare beneficiaries -- out of a total of about 40 million aged and disabled Americans - have enrolled in Medicare HMOs. Original fee-for-service Medicare, currently chosen by more than 35 million beneficiaries, is available to all beneficiaries. Unlike traditional HMOs, the new options will allow beneficiaries who choose to enroll, access to services provided outside the contracted network of providers.
The demonstration program, announced in August 2002, includes new health plans that will ultimately be available in 23 states across the country, expanding health care options to approximately 11 million Medicare beneficiaries.
The demonstration plans are considered Medicare+Choice plans and must offer all of Medicare's required benefits, but also have the flexibility to offer additional services, including prescription drugs. Most important, they offer beneficiaries a wider choice of health care providers than is currently offered in HMOs.
A number of resources with information regarding the plan offered by Community Insurance are available as part of various CMS consumer information sources, including a national toll-free phone number -- 1-800-MEDICARE (1-800-633-4227) or TTY/TDD, at 877-486-2048, and the CMS Internet site -- www.medicare.gov. In addition, a coalition of more than 200 national and local organizations is available to assist seniors in making informed decisions about their health care options.